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Cardiovascular Disease After Spinal Cord Injury

More than two decades have passed since cardiovascular diseases emerged as a major health concern for persons with SCI.1,2,3 In the years that immediately followed World War II, genitourinary complications accounted for 43% of deaths after SCI, although mortality from these causes was reduced to 10% of cases in the 1980s and 1990s.2,4 Cardiovascular diseases (CVDs) currently represent the most frequent cause of death among persons surviving more than 30 years after injury (46% of deaths) and among persons more than 60 years of age (35% of deaths).5 Of special concern is the accelerated rate at which CVD appears in those with SCI.4,6,7 Asymptomatic CVD after SCI appears at an earlier age8 and may have symptoms that are masked by interruption of sensory pain fibers that normally convey warnings of cardiac ischemia and imminent cardiac damage.9,10 The latter makes delays in emergent treatment needed to prevent impending myocardial damage and cardiac dysfunction a strong possibility, especially for those with higher levels of SCI and greater loss of sensory function.11

Several major risk factors commonly reported in persons with SCI have been linked with their accelerated course of CVD; these include an atherogenic dyslipidemia,12 hyper-insulinemia,13,14,15 and visceral obesity.16,17 An atherogenic lipid profile has been widely reported in persons with chronic SCI.15,16,17,18,19,20,21,22,23 The most consistent finding of this dyslipidemia is a depressed blood plasma concentration of the high-density lipoprotein cholesterol (HDL-C),6,17,24,25 whose functions include protection against development of vascular disease.26 More than 40% of young persons with SCI have HDL-C levels that failed to meet authoritative targets. This risk is commonly accompanied by other health hazards, including visceral obesity,16,17 elevated body mass indices,16 physical inactivity,27,28 reduced lean body mass,5,29,30,31 diabetes,6,32 insulin resistance with obesity and dyslipidemia (metabolic syndrome X),33 and advancing age,34...